Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan.
Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan.
Int J Mol Sci. 2023 Mar 9;24(6):5270. doi: 10.3390/ijms24065270.
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child's developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients' clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
共病在癫痫患儿中很常见，近一半的患者至少有一种共病。注意缺陷多动障碍（ADHD）是一种精神障碍，其特征为多动和注意力不集中的程度与儿童的发育阶段不成比例。癫痫患儿的 ADHD 负担很高，会对患者的临床结局、社会心理方面和生活质量产生不利影响。有几个假说被提出解释儿童癫痫中 ADHD 负担高的原因；癫痫和共患 ADHD 之间确立的双向联系和共同的遗传/非遗传因素，在很大程度上排除了这种关联的偶然性。兴奋剂对共患 ADHD 的儿童有效，目前的证据支持在批准剂量内使用的安全性。然而，安全性数据应在随机、双盲、安慰剂对照试验中进一步研究。共患 ADHD 在临床实践中仍未得到充分认识。早期识别和管理共患 ADHD 对于优化预后和降低不良长期神经发育结局的风险至关重要。癫痫和 ADHD 的共同遗传背景的识别可以为这些患者通过精准医学定制治疗方案开辟道路。
